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mechlorethamine (Rx)Brand and Other Names:Mustargen, mechlorethamine hcl, more...Nitrogen Mustard

 
 
 

Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

powder for injection

  • 10mg/vial
more...

Cancers

Leukemia/Lymphomas/Polycythemia Vera/Mycosis Fungoides/Bronchogenic Carcinoma

0.4 mg/kg IV divided over 2 or 4 days 

Combo treatment (MOPP regimen): 6 mg/m²/day IV days 1 and 8 q4Weeks

Do not repeat course until WBC >1000/mm³ & plateletes >50 k/mm³

Metastatic Carcinoma

Intracavitary: 0.4 mg/kg once 

Intrapericardial: 0.2 mg/kg once

Mycosis Fungoides (Orphan)

Orphan indication sponsor

  • Yaupon Therapeutics, Inc; 259 Radnor Chester Road; Radnor, PA 19087

Administration

Monitor

  • CBC, renal, hepatic, & bone marrow functions
  • Adjust subsequent dose based on WBC, platelete counts

Other Indication & Uses

Intrapleural, intraperitoneal, intrapericardial

Off-label: Cutaneous mycosis fungoides (topical application)

Safety & efficacy not established

Cancers

Leukemia/Lymphomas/Polycythemia Vera/Mycosis Fungoides/Bronchogenic Carcinoma

0.4 mg/kg IV divided over 2 or 4 days 

Combo treatment (MOPP regimen): 6 mg/m²/day IV days 1 and 8 q4Weeks

Do not repeat course until WBC >1000/mm³ & plateletes >50 k/mm³

Metastatic Carcinoma

Intracavitary: 0.4 mg/kg once 

Intrapericardial: 0.2 mg/kg once  

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Interactions

Interaction Checker

mechlorethamine and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            > 10%

            Severe nausea/vomiting (90%)

            Frequency Not Defined

            Vertigo

            Chills

            Fever

            Tinnitus

            Thrombosis

            Angioedema

            Dyspnea

            Hemolytic anemia

            Hyperuricemia

            Myelosuppression

            Jaundice

            IV site pain

            Skin rash

            Dermatitis

            Erythema multiforme

            Urticaria

            Fertility impairment

            Amenorrhea

            Oligomenorrhea

            Azoospermia

            Oligozoospermia

            Allergic reactions

            Anaphylaxis

            Alopecia

            Aggravation of amyloidosis

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            Warnings

            Black Box Warnings

            Caution in handling and disposing of the drug

            The drug should be administered under the supervision of an experienced cancer chemotherapy physician

            If extravasation occurs, it may cause severe tissue damage, leading to ulceration and necrosis

            Avoid exposure during pregnancy

            Contraindications

            Hypersensitivity, history of anaphylaxis

            Active infection

            Cautions

            Amyloidosis

            Blood coagulation disorder may occur

            Bone marrow depression (leukopenia, thrombocytopenia, anemia)-potential contraindication in CLL

            Risk of hyperuricemia

            Bone & nervous tissue tumors have responded poorly to therapy

            Vesicant (avoid extravasation)

            Avoid pregnancy

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            Pregnancy & Lactation

            Pregnancy Category: D

            Lactation: not known if excreted in breast milk, do not nurse

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Inhibits DNA & RNA synthesis, via formation of carbonium ions; cross links DNA strands (interstrand and intrastrand crosslinking) causing miscoding breakage and subsequently DNA replication failure

            Pharmacokinetics

            Half-life elimination: <1 min

            Metabolism: Extensive (within minutes; rapid demethylation and hydrolysis)

            Excretion: Urine

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            Administration

            IV Incompatibilities

            Solution: D5W, NS

            • However only 10% drug loss in both fluids

            Additive: methohexital

            Y-site: allopurinol, cefepime

            IV Compatibilities

            Y-site: amifostine, aztreonam, filgrastim, fludarabine, granisetron, melphalan, ondansetron, sargramostim, teniposide, vinorelbine

            IV Preparation

            Must be used fresh, solution is stable for only 1 hr after dilution & must be administered within 1 hr

            Do not use if solution is discolored or if water droplets visible prior to reconstitution

            Dilute powder with 10 mL SWI to a final concentration of 1 mg/mL; may be diluted in up to 100 mL NS for intracavitary administration

            Standard dilution

            • IV push: dose/syringe (concentration: 1 mg/mL)
            • Maximum syringe for IVP is 30 mL & syringe should be <75% full

            IV Administration

            Vesicant, do not give IM/SC

            Margin of error is very slight

            Administer IVP through sidearm of free flowing IV (preferred) or direct injection into vein over a few min

            Flush with 5-10 mL NS

            Extravasation Management

            Sodium thiosulfate1/6 M is specific antidote for nitrogen mustard extravasations

            • Mix 4 mL of 10% sodium thiosulfate with 6 mL SWI (or 1.6 mL 25% Na-thiosulfate with 8.4 mL SWI)
            • Aspirate residual drug & remove needle
            • Inject antidote (2 mL for every 1 mg of drug extravasated) into SC tissue clockwise into infiltrated area using 25 gauge needle
            • Time is essential in treating extravasation
            • Heat & cold not proven effective

            Storage

            Store intact vials at room temp

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            Images

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            Formulary

            FormularyPatient Discounts

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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